Ulnar neuropathy is a condition involving impaired movement or sensation in the wrist and hand caused by damage to the ulnar nerve. Ulnar means pertaining to the hand, forearm and elbow and neuropathy means a disturbance to the peripheral nerve system. Ulnar neuropathy, or ulnar nerve dysfunction, is a form of peripheral neuropathy. Ulnar tunnel syndrome is a specific ulnar neuropathy. The ulnar nerve travels from the shoulder down the outside of the arm, supplying flexion to the wrist and aiding in movement and sensation of the wrist and hand, to the fourth and fifth fingers in particular. The ulnar nerve is near the surface of the body where it crosses the elbow, so prolonged pressure on the elbow or entrapment of the nerve may cause damage.
Ulnar neuropathy is a degeneration of the ulnar nerve. Ulnar neuropathy is marked by numbness, tingling, or pain in the arm and hand on the side of the little finger and the outer side of the palm. In addition to these sensory symptoms, in more advanced cases, weakness and loss of muscle in the hand may also occur. Elbow pain is frequent in this condition and many people will notice that touching their elbow the wrong way causes a sharp shooting pain to descend down the arm into the fingers.
Ulnar neuropathy can affect persons of any age, although it is more common in older individuals, after traumas, including fractures to the arm, and in individuals who lean on their elbows when speaking on the telephone or sitting in a chair with arms. Some conditions such as diabetic neuropathy can also predispose one to having ulnar neuropathy.
Causes of ulnar neuropathy include: prolonged external pressure on the nerve at the elbow, where the ulnar nerve is close to the surface of the body, or at the base of the palm; direct trauma, such as fracture or dislocation of the elbow; or compression of the nerve at the elbow or wrist from soft-tissue swelling, bone spurs, or damage to the myelin sheath that encases the nerve.
Ulnar neuropathy treatment may start conservatively with avoidance of postures that may injure the nerve. The patient should avoid using the hand, especially for activities involving small muscle movement of the hand, like typing and dialing the telephone. The patient may also wear a protective pad around the elbow.
Additional conservative treatments include simple nerve flexing exercises, nocturnal splinting or night-time braces to keep the arm straight, and medications to help alleviate symptoms and decrease swelling and pain, including anti-inflammatory medications and various forms of analgesics. In more extreme cases, steroids may be injected to reduce swelling and pressure on the nerve. If symptoms are unresponsive to more conservative treatment, or there is evidence of nerve degeneration, surgical intervention can be pursued.
Although there is solid evidence the ulnar neuropathy most often results from compression of the ulnar nerve, current treatments are not very effective and surgery is often the only resort for severely effected patients. The surgical procedure of choice is an ulnar transposition. As constant stretching and compression of the nerve is the culprit, simply moving the nerve to the superior medial aspect of the elbow is often sufficient in stopping pain. This transposing of the nerve will often stop further muscle wasting as well, but atrophy present in the hand may be irreversible. Surgery for the ulnar nerve is complex and the outcome, in terms of relief of symptoms and improvement in strength, is often not as good.
Use of an elbow splint at night will keep the elbow from being bent during sleep. Splint application alone may be adequate to improve the symptoms and ulnar nerve conduction across the elbow. A pad around the elbow during the day will protect the nerve from trauma. The pads are often elbow pads or guards that are used for sports and available from sporting goods stores. Splint and elbow pads may also be custom made by a hand therapist, a specialist center or a physical therapist. These interventions have little proven efficacy, can be expensive, and lack credibility in the patients' view.
Examples of elbow orthosis, pads, protectors and braces are known in the art. U.S. Pat. No. 6,730,052 discloses an elbow brace for supporting a person's elbow in a desired, fixed position comprising a sleeve, a pocket formed in the sleeve, a single pad enclosed within the pocket, and a pair of straps extending from the sleeve. U.S. Pat. No. 5,569,172 discloses an orthopedic pillow device for supporting and immobilizing a patient's arm relative to a patient's shoulder comprising a portable, L-shaped, reversible, pillow and a plurality of straps for attaching and securing the pillow to both the patient's upper torso and arm. U.S. Pat. No. 5,514,081 discloses an elbow orthosis having an inflatable bladder support and method of use. U.S. Pat. No. 6,551,280 discloses therapeutic devices and systems that provide support or pressure to tissue.
Thus, there is a need in the art for an apparatus and method for treating ulnar neuropathy that is effective, safe, comfortable, affordable and readily available.